Generate and process denial letters and Notice of Action (NOA) for pre-services, leveling of care and denied medical services.
High school diploma or equivalent. 2+ years of related managed care experience and medical terminology. Associate’s degree preferred.
• Maintain the denial and/or appeals logs and assessments in accordance with associated guidelines
• Responsible for the Medical Management denial process including letter printing, tracking and disposition of letters within contractual guidelines to ensure compliance
• Serve as the department liaison for all denial and/or appeals issues
• Train others on denial and/or appeals work processes
• Prepare monthly, quarterly, and annual reports for denials and/or appeals
• Review log to ensure compliance with the denial process and turn-around timeframe (TAT) for all denial and/or appeals notifications
Centene is sensitive to the needs of individuals and families enrolled in government-assisted health programs. The company provides managed...